Background: Hepatitis C virus (HCV) can lead to increased mortality, disability, and liver transplantation if left untreated, and it is associated with a possible increase in disease burden in the future, all of which would surely have a significant impact on the health system. New antiviral regimens are effective in the treatment of the disease yet expensive. Objectives: The purpose of the present study was to assess the cost-effectiveness of three medication regimens, namely, ledipasvir/sofosbuvir (LDV/SOF), velpatasvir/sofosbuvir, and daclatasvir/sofosbuvir (DCV/SOF) for HCV patients with genotype 1 in Iran. Methods: A Markov model with a lifetime horizon was developed to predict the costs and outcomes of the three mentioned medication therapy strategies. The final outcome of the study was quality-adjusted life-years (QALYs), which was obtained using the previously published studies. The study was conducted from the perspective of the Health Ministry; therefore, only direct medical costs were estimated. The results were provided as the incremental cost-effectiveness ratio (ICER) per QALY. Ultimately, the one-way and probabilistic sensitivity analyses were used to measure the strength of study results. Results: The results showed that the QALYs for LDV/SOF, DCV/SOF, and VEL/SOF were 13.25, 13.94, and 14.61, and the costs were 4,807, 7,716, and 4,546$, respectively. The VEL/SOF regimen had lower costs and higher effectiveness than the LDV/SOF and DCV/SOF regimens, making it a dominant strategy. The tornado diagram results showed that the study results had the highest sensitivity to chronic hepatitis C (CHC) and compensated cirrhosis (CC) state costs. Moreover, the scatter plots showed that the VEL/SOF was the dominant therapeutic strategy in 73% of the simulations compared to LDV/SOF and 66% of the simulations compared to DCV/SOF; moreover, it was in the acceptable region in 92% of the simulations and below the threshold. Therefore, it was considered the most cost-effective strategy. Moreover, the results showed that DCV/SOF was in the acceptable region below the threshold in 69% of the simulations compared to LDV/SOF. Therefore, the DCV/SOF regimen was more cost-effective than LDV/SOF. Conclusions: According to the present study results, it is suggested that the VEL/SOF regimen be used as the first line of therapy in patients with HCV genotype 1. Moreover, DCV/SOF can be the second-line medication regimen.
Background & aim:The study of educational environments in teaching hospitals has been recommended by many countries on an ongoing basis. In medical science education environments, in order to organize students' behavior, it is necessary to adjust and adapt the content and educational environment to each other as two important factors in the development of medical sciences. The aim of this study was to determine and study the atmosphere of teaching hospitals in Abadan University of Medical Sciences from the perspective of clinical students and its relationship with the performance of managers. Methods: the present cross-sectional study was conducted in educational hospitals under the auspices of Abadan School of Medical Sciences in 2019. Research tools were two valid and reliable questionnaires. The "Dundee Ready Educational Environment Measure questionnaire" was used for the educational environment and the "managers' performance questionnaire" was used to evaluate the managers of the departments. Sampling was done by census and 204 students and 32 heads of clinical departments were included in the study. The collected data were analyzed using descriptive tests (frequency and percentage, mean and standard deviation) and analytical tests of t-test, analysis of variance and Pearson correlation. Results:The performance of managers was strong (mean score was 68.75±7.39). Each of the different areas of managers' performance had a positive and significant relationship with each other. Educational atmosphere was also favorable (mean score 113.35±22.59). There was no significant relationship between educational atmosphere and managers 'performance and each of the managers' performance areas. Conclusion:Due to the dissatisfaction of one third of students with the educational atmosphere in Abadan University of Medical Sciences in clinical departments and not so high score in the dimension of planning in the performance of managers, educational processes need careful planning and implementation of standards.
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